Provider Demographics
NPI:1841476637
Name:TRI-CITIES CENTER FOR CHRISTIAN COUNSELING
Entity type:Organization
Organization Name:TRI-CITIES CENTER FOR CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KITZMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-MHSP
Authorized Official - Phone:423-246-5111
Mailing Address - Street 1:1111 N EASTMAN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3156
Mailing Address - Country:US
Mailing Address - Phone:423-246-5111
Mailing Address - Fax:423-246-5288
Practice Address - Street 1:1111 N EASTMAN RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3156
Practice Address - Country:US
Practice Address - Phone:423-246-5111
Practice Address - Fax:423-246-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1088106H00000X
TN2220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty